Background: Pneumocystis jirovecii pneumonia(PJP) in solid organ transplant (SOT) recipients carries significant morbidity and mortality. There is mounting evidence for ongoing risk of PJP in SOT patients years after their transplant, which may include person-to-person transmission. Beta-D-glucan (BDG) has been shown to be elevated in PJP, but has not been used to define cases. During an evaluation of a cluster of PJP in SOT patients at our institution, we employed BDG to screen for cases.

Methods: In a case-control study, we identified PJP cases in SOT patients retrospectively by screening for BDG values >80 from 12/2014 to 11/2017. Cases were reviewed and included if they met clinical criteria for disease. We matched controls 2:1 on organ transplanted, month and year of transplant, HIV status, gender and age when possible. We also performed case mapping, looking at contacts between cases one year prior to their PJP diagnosis to determine plausibility of person-to-person transmission. Contact was defined as being in the same location on the same day as a case within 6 months of the PJP diagnoses.

Results: We identified 24 cases (23 renal and 1 liver transplant) and 48 controls. The average time from transplant to PJP diagnosis was 1826 days (range 258-6259, SD=1721). Three cases died (mortality rate 12.5%). All cases were on similar immunosuppressive drug regimens. Compared to controls, cases were more likely to have had a detectable cytomegalovirus (CMV) viral load (OR=5.0 [1.13-22.18] p=0.01). There was insufficient evidence to associate rejection or total lymphocyte count with PJP. Case mapping showed that 21 (88%) of the cases had a defined contact; most interactions occurred at transplant clinic visits.

Conclusions: BDG was an effective method for case identification and can be included when defining PJP in SOT. As reported in previous studies, CMV was associated with disease, but the nature of the relationship requires further definition. Given the plausibility of transmission, this evaluation has informed our intervention plans for short-term universal prophylaxis, lifelong prophylaxis of cases, and continued monitoring for new cases.

CITATION INFORMATION: Mittal J., Mogollon J., Cowman K., Nori P., Muggia V., Minamoto G., Puius Y. Serum Beta-(1,3)-D-Glucan as a Case-Finding Tool during an Outbreak of Pneumocystitis jirovecii Pneumonia in Abdominal Transplant Patients Am J Transplant. 2017;17 (suppl 3).

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